2: Biography John S Silverton MD, FRCS Dr. John Silverton was born and raised in England. He was educated at Eton College, Windsor and studied medicine at St. Bartholomew's Hospital Medical College, University of London. After completing the required internships he studied General Surgery and passed the examinations to become a Fellow of The Royal College of Surgeons of England, and a Fellow of the Royal College of Surgeons of Edinburgh. He then studied plastic surgery at Stoke Mandeville Hospital, Aylesbury, and at Canniesburn Hospital in Glasgow, Scotland. He completed his plastic surgery training at Emory University in Atlanta. He became an Assistant Professor of Plastic Surgery at the University of California, Davis for two years. He then started his private practice in Stockton, California in 1979 where he continues to practice today. Dr. Silverton was Chairman of the Department of Surgery at Dameron Hospital for 6 years. Dr. Silverton has published numerous professional articles and a plastic surgery textbook. Currently, Dr. Silverton confines his practice to aesthetic surgery with particular emphasis on surgery of the trunk. He is widely known for his consistently good results in breast aesthetic surgery including breast implants and lifts. Dr. Silverton has pioneered new techniques in abdominoplasty, including liposuction abdominoplasty, in which results have been dramatically improved. At the same time return to work and recovery time has been significantly shortened, while also improving safety and reducing complication rates and improving patient outcomes and satisfaction. Dr. Silverton performs most of his procedures at the state-of-the-art Trinity Plaza Surgery Center in Stockton, California.

3: Dr. Silverton's Qualifications Certified by the American Board of Plastic Surgery * * * Fellow of the Royal College of Surgeons of England Fellow of the Royal College of Surgeons of Edinburgh * * * Member of the American Society of Plastic Surgeons Member of the American Society for Aesthetic Plastic Surgery Member of the California Society of Plastic Surgeons

4: A tummy tuck is also known as an abdominoplasty. It is one of the most common cosmetic procedures performed in my practice. Loose skin and stretch marks often develop after pregnancies. Excess fat can accumulate in the tummy area with weight gain. When the fat is lost with dieting and exercise the extra skin remains. It might sag and form an area of overhanging skin. Stretch marks can look bad. Often this is cosmetically unacceptable, but every patient is different. Your particular problem will be examined and evaluated individually. I will customize the procedure for you. Although the anatomy of the abdominal wall is quite complicated it can be broken down to three distinct layers – muscle, fat and skin. We need to decide if one or more of these layers is your particular concern. If it is fat only, then liposuction might be appropriate. Liposuction will not tighten skin or muscles. | Liposuction With liposuction I make small punctures – usually three. I inject some clear IV fluid containing epinephrine. I treat the skin with ultrasound applied to the skin surface. I suction using the syringe liposuction method where there is no machine. The vacuum of the syringe provides all the suction power that is needed. When performed for the right patient, this procedure can produce outstanding aesthetic results.

5: Mini Tummy Tuck (Mini Abdominoplasty) If you have a moderate or small amount of fat and and also a limited amount of loose skin a mini abdominoplasty might be the right choice. A mini abdominoplasty is liposuction plus skin removal from the lower abdomen. This will tighten the lower abdomen, below the belly button. The belly button is not moved with this technique and it acts as a tethering point making it impossible to tighten the upper abdominal skin with this method. However, for some people whose extra skin is confined to below the belly button and whose upper abdominal skin does not need correction, and whose muscles are not too weakened or stretched, a mini tummy tuck or mini abdominoplasty might be a great choice. With a mini abdominoplasty recovery is quick, and no drains are required. It also costs less. However, most people do not fall into this category because the fat and extra skin and stretch marks are spread out throughout the whole abdomen, including the area above the belly button. If you are in this category, a full tummy tuck might be the best answer. | Complete Tummy Tuck (Liposuction Abdominoplasty) The full tummy tuck and been significantly improved on the standard version. The results are much better than they were before, and recovery is quicker. All our tummy tucks are done as an outpatient. You go home the same day. In order to explain the new technique and new improvements I would like to comment on the old standard technique first. The old technique has been popular for the past 30 years or so. It consists of making a long cut across the lower abdomen where it will normally be covered by clothing. The skin and fat is lifted upwards off the muscles to the ribs. When the belly button is reached it is preserved by making a cut in the skin all around it. The skin of the stomach looks a bit like an apron as it is lifted upwards and there is a hole where the belly button used to be. The muscles may have spread apart due to pregnancy. This is corrected by pulling the muscles together again in the mid-line with stitches. This creates a flatter firmer abdominal wall and a slimmer waistline. The skin and fat is now stretched downwards and the excess is trimmed off at the level of the original incision. The incision is now closed after inserting drains. At this time the belly button is now covered by skin. A hole is made right over where the belly button is. It is located and brought through. Your belly button is now restored.

6: This is the old technique and it has three major problems: 1.The fat under the skin that remains has not been removed. 2.There is a large potential space where two large surfaces can rub together. This space needs to be drained and this space can cause problems. 3.There is a risk of skin dying just above the pubic area resulting in delayed healing or a hole that needs prolonged dressing care. This is due to poor blood flow in this area. This risk is greatly increased in smokers. Over the past several years we have done a lot to improve the technique and get around these problems. We think that we have all of these problems solved now. Now we do liposuction of the entire abdomen to remove the excess fat. This has the effect of mobilizing the skin without cutting anything. Then we lift the skin and the lower abdominal tissue to the level of the belly button, but not as high as before. We save the belly button in the same way as before. We create a tunnel upwards from the belly button to the upper abdomen so that we can tighten the muscles from the top to the bottom at the pubic area. | What we do not do is to elevate the skin to the ribs on both sides. This preserves the blood flow to the skin above the pubic area. The skin can get tight and move down just as much as before because it is loosened by the effects of the liposuction. I can explain exactly how this works when I see you in person for the consultation. So now the procedure is safer with much better healing, and better blood flow to the skin above the pubic area. The actual surgery on your tummy is less. The drains stay in for a shorter time, because there is no longer a large potential space that needs to be drained. Recovery is quicker. Pain and discomfort is less. We use a pain pump to lessen the pain even more. ... and best of all the results are very much better than before.

7: Discussion If you think you need to improve the appearance of your tummy, please call now for a consultation. Together we will discuss your individual situation and decide on a plan to suit your desires, your fears, and your needs as well as your pocket book! Ask about our many financing options. Please do not have unrealistic expectations. This can lead to disappointment. Making the decision as to exactly what you want to get done is a team effort. Both you and I must discuss these procedures after I have examined you. All decisions are trade offs. For instance – to get a tighter tummy you must accept that a cosmetic surgery procedure is necessary. That is a trade off. It is not magic! Another trade off might be that you accept that you will have a scar in order to get the improved tummy that you want. All the risks of the procedure are trade offs. | A lesser procedure might be OK for you even if it produces a lesser result, if you want less surgery, less expense, less risk and a quicker recovery. Or you might want to go the whole way and get the best possible tightening and go for the best result, and you accept that there are some more risks, and recovery can be longer than for the lesser procedure. These procedures can be great procedures when they are done for the right reasons on the right person. Are you the right person? I enjoy this challenge and I am committed to getting the very best possible results for you. Remember - Please ask questions if you are not sure about something.

13: The After pictures were taken soon after the procedure. They will be updated as soon as we get newer pictures.

15: The After pictures were taken soon after the procedure. They will be updated when we get newer pictures.

16: Heavier patients get a big improvement, but it would help to lose weight first. There are also safety issues.

25: The After pictures are taken soon after the procedure. They will be updated when we get newer pictures.

27: The After pictures were taken soon after the procedure. They will be updated as soon as can get newer pictures.